Health Insurance Can I claim twice for health expenses if I am insured twice?

[holaquetal]

I happen to have 2 medical insurance, with 2 different providers. One is the one that my employer offers and the other one is the one that my wife's employer offers, she can add family members at no extra cost. I want to know if the following scenarios would constitute insurance fraud, so I can avoid the if so:

1. To claim the same medical receipt (i.e. GP) to both my insurance and my wife's. Premiums are paid for both, so I am wondering if I can submit the same receipt to both of them.
2. My insurance covers 100% of GP cost 5 times, and then it's 50%, whereas my wife insurance covers 75% of all GP visits without limit. I have now reached my 5 GP visits this year. Is it fraud to start submitting future claims through my wife's medical insurance only, so I can get a higher % of the cost of the GP visit?

Thanks,

 

[Gordon Gekko]

There is a cost to essentially being overinsured...the benefit in kind taxation on the additional premium.

I would have thought that 1. is a fraud and 2. is not, but I'm no expert.

 

[Boyd]

I actually didn't think it was legal to have two health insurance policies. I used to work for in the industry and was told this was the case. I would double check what you have in place is above board before attempting to claim.

 

[mathepac]

I'd have thought 2. was OK, and any other scenarios where you're not claiming twice for the same procedure / consultation.

 

[odyssey06]

Some insurers will look for the original receipt and will issue you back a statement of claim, so you may have practical difficulties in claiming twice unless you get two receipts issued by the GP which is bound to raise alarm bells.

 

[Branz]

1 is insurance fraud under what are known as subrogation rules.
I think you will also find that on the claim forms for both a declaration that you have not recovered the claimed item from anyone else.
I know you will argue that you are not doing this as you sign one and your wife signs the other but its hardly worth your jobs if its picked up: companies are always looking for stuff to have on file...

 

[Northie]

Not quite the same, but had school insurance for my son who was also covered by his dad's work vhi policy. He had an accident and ended up in A&E, VHI covered 50% of this cost. The insurance policy for my son covered the remainder. The claim form for the school insurance specifically asked if any money had been recovered from other insurance, highlighted the payment from VHI, received cheque for the remainder.

My understanding was that you couldn't receive payment twice for the same receipt but that once you hit your max 5 visits under your own policy that any remaining visits could be claimed from your wife's

 

[Clara16]

VHI day to day claim form for GP visits clearly asks:

In accordance with the Claims Section of your Rules, Terms and Conditions, if other insurance is held that would provide benefit for any of


the receipts being claimed you must tell us. Please indicate below:


4.1 Is other insurance held which would cover any of these receipts? Yes No

Have you been saying No to this question?

surely your wife is paying a high BIK on your insurance premium each month. you could look at saving this?

 

[DirectDevil]

I am a little unsure about the reference to subrogation in this context. Subrogation is the right of one party who has indemnified another to avail themselves of the rights and remedies available to the indemnified party.

However, where two or more policies appear to cover the same loss there can be contribution between the insurers.

Contribution is subject to certain rules which the insurers will know. If the contribution rules are satisfied contribution will apply and the insurers will apportion the loss between themselves.

If the contribution rules are not satisfied then the principal does not apply but that does not mean that there is an automatic entitlement to double indemnity. Policy wordings may also provide some guidance as to what is possible.

The principal of indemnity is that the claimant shall be placed in the position they occupied as at the time of the loss and that does not include making a profit on the loss ! Therefore, you cannot receive double indemnity in the strict sense.

If a person knowingly sought to secure double indemnity that might lay the basis for a charge of fraud.

 

[Branz]

However, where two or more policies appear to cover the same loss there can be contribution between the insurers.

Yes when both companies know about it being the same loss.
The rights here is the medical bill so once you claim under 1, the bill is no longer your to claim again.